Impact of Pharmacist Education on Inhaler Technique and Adherence in an Outpatient Clinic.

Background and Objectives: To assess the impact that pharmacist education has on proper inhaler technique and adherence in a teaching clinic. Methods: This was prospective, non-randomized, pre-test/post-test study. Patients were 18 years or older, had a diagnosis of asthma or COPD, and prescribed at least 1 inhaled medication. Initial visits consisted of a baseline asthma control test (ACT) or COPD assessment test (CAT), the Test of Adherence to Inhalers (TAI), and a baseline inhaler technique evaluation. The pharmacist then educated the patient. Then inhaler technique was assessed again (post-education inhaler technique evaluation #1). Follow-up visits occurred 4 to 8 weeks later. ACT or CAT and TAI test were administered and inhaler technique was assessed again (post-education inhaler technique #2). The primary outcome was the comparison of the percentage of correct steps performed from baseline to post-education inhaler technique evaluation #1 and from baseline to post-education inhaler technique evaluation #2. Results: Eighteen patients were included, with a mean age of 58 years old. Over half had asthma, were female and African American. There was a significant difference in inhaler technique from baseline to post-education inhaler evaluation #1 and from baseline to post-education inhaler evaluation #2. The most common step missed was no exhalation before inhalation. There was no significant difference when comparing the individual and overall TAI test scores from initial to follow up visit. Conclusions: This study supports pharmacist-led inhaler technique education.

Pharmacist Hypertension Management Quality Review at an Ambulatory Care Clinic.

Background: A reduction of 10 mm Hg in systolic blood pressure (SBP) significantly decreases the risk of major cardiovascular disease events. Pharmacists' management of blood pressure may assist with this reduction. Objective: Assess the impact of pharmacist management of hypertension via a collaborative practice agreement with physicians in an ambulatory care clinic. Methods: The first phase of this study was a retrospective chart review of physician/nurse hypertension visits from October 2019 to August 2020. The second prospective phase consisted of pharmacist managed hypertension visits from December 2020 to January 2021. The primary outcome was the change in SBP from the beginning to the end of the study period in the prospective group. Secondary outcomes included the proportion of patients achieving their blood pressure goal and the proportion of patients adherent to all antihypertensive medications at their follow-up visits in both groups. This study was institutional review board approved. Results: Forty-seven patients were included and analyzed (24 in the retrospective group and 23 in the prospective group). Patients in the prospective group had an average SBP lowering of 10.83 mm Hg (P = .0035). Thirteen patients (56.5%) met their blood pressure goal of <130/80 mm Hg in the prospective group, compared to 5 patients (20.8%) in the retrospective group (P = .012). One adverse event occurred during this study. Limitations included small sample size and short duration of study. Conclusion: Patients had an average SBP lowering of >10 mm Hg. More patients reached a goal blood pressure of <130/80 mm Hg when managed by pharmacists.

The Impact of Face-to-Face Pharmacist Transitional Care Management Visits on Medication-Related Problems.

Background: Studies are needed to evaluate medication-related problems (MRPs) to assess the effect of a pharmacist on managing medications postdischarge. Objective: To assess the ability of pharmacist-led medication review and reconciliation to reduce the number of MRPs found in transitional care medicine (TCM) visits, leading to medication optimization. Methods: This study involved a retrospective chart review of standard TCM procedure at a family/internal medicine clinic and a prospective, team-based TCM visit in the same clinic. Inclusion criteria included patients discharged from any hospital within our institution and seen in the clinic. The primary outcome was the difference in the proportion of MRPs found between the prospective and retrospective groups. Secondary outcomes included the number and specific type of MRPs found, classified by the Pharmaceutical Care Network Europe tool, and further subdivided by patient aware or unaware of MRP, only in the prospective group, as well as 30-day readmission rate. Results: Patients in the prospective group (n = 50) had an average age of 67.9 years versus 65.5 years in the retrospective group (n = 50). Four times as many patients in the prospective group were found to have MRPs than the retrospective group. The most common MRP was due to a patient-related factor, meaning the cause is related to a patient's behavior. Patients were unaware of the MRP in a majority of these cases. Thirty-day readmission rate did not differ between the groups. Conclusion: Team-based TCM visits that included a pharmacist-led medication reconciliation uncovered more MRPs than patients who did not have a pharmacist perform a medication reconciliation.